A wide range of serious gastrointestinal (GI) symptoms, such as incontinence, diarrhoea, rectal bleeding, sexual dysfunction, and other irritable bowel syndrome (IBS)-type symptoms can develop following oncology treatment.
However, these patients are often not adequately investigated, followed-up or treated correctly for these painful and debilitating cancer- and treatment-related side-effects, the Irish Society of Gastroenterology (ISG) Winter Meeting heard.
Leading UK expert in managing onco-related GI issues, Prof Jervoise Andreyev, Consultant Gastroenterologist, Lincoln County Hospital, UK, gave a presentation titled ‘Challenging our management of IBS using principles derived from onco-gastroenterology’. In his talk, he focused on the presentation of bowel issues.
Issues like diarrhoea induced by chemotherapy in cancer patients are common and cause notable morbidity, but are managed inconsistently, Prof Andreyev commented. These patients are often told they simply have IBS, when this is not the case. And despite the huge impact on quality-of-life, these patients are often “fobbed off and told they are lucky to be alive and to stop complaining”.
However, much can be done, Prof Andreyev maintained, with a step-by-step approach starting with appropriate tests for each symptom to identify which physiological deficits are present, “and then obvious treatment solutions will emerge”.
“Basing GI diagnoses on ‘symptom clusters’ is inadequate,” he added.
Prof Andreyev used a case study patient ‘Sarah’ to illustrate his points. Sarah was seven years post-surgery and radiotherapy treatment for cervical cancer. She was now suffering significant GI issues – her bowels were opening up 12 times a day, several times at night, and she had daily incontinence and intermittent steatorrhoea, pain, and other symptoms. However, she was constantly being told ‘nothing could be done’. This was not true, Prof Andreyev stated, and outlined how with appropriate diagnostics and treatment (for bile acid malabsorption, small bowel bacterial overgrowth, and gastric bile reflux, etc), her symptoms swiftly resided.
He discussed a detailed algorithm-based management approach for patients with GI symptoms after pelvic radiation treatment, of which he led the development. The results of research validating its use confirmed its clinical and cost-effectiveness.
Concluding, Prof Andreyev said a rigorous diagnostic approach should become the standard of care before a diagnosis of IBS is made, which is more cost-effective and accessible in the long run.
Also speaking at the meeting was Prof Brian Saunders, Consultant Gastroenterologist and Specialist Endoscopist, St Mark’s Hospital and Imperial College, London, UK, who discussed optimal polyp management and what techniques are best for different types. Looking at large non-pedunculated polyps he said while this lesion is not a cancer, “it is as important as cancer and should be treated as such. Get it right the first time”.
ISG 2024 Winter Research Abstract Winners
First – Top Oral
Dr Clare Foley, Liver Centre, Mater Misericordiae University Hospital, Dublin
Abstract 24W137: Burden of alcohol related liver disease admissions over six years in Ireland
Second – Top Oral
Dr Ashley Lloyd, St Vincent’s University Hospital (SVUH), Dublin
Abstract 24W156: The DETECTION Study: DETection by Endoscopy of Colitis in Screening ImplementaTION
Third – Top Oral
Mr Stephen Molloy, Trinity College Dublin (TCD)/Tallaght University Hospital (TUH), Dublin
Abstract 24W139: Two birds, one set of biopsies: The use of PCR for the diagnosis of Helicobacter pylori and detection of resistance using biopsies from bedside rapid urease tests
Themed Oral Presentations – IBD and Other GI
First Award
Dr Conor Costigan, TCD/TUH, Dublin
Abstract 24W129: Bismuth quadruple therapy with doxycycline is an effective first-line therapy in an Irish cohort for Helicobacter pylori
Second Award
Dr Ciarán McHale, Beaumont Hospital, Dublin/RCSI
Abstract 24W121: Myopaenia at induction is associated with non-response in patients with IBD commencing biologics
The ISG Training/Observership Bursary 2024
awards went to:
Dr Mary Nwaezeigwe, SVUH
Dr Aoife Alvain, SVUH
Dr Susanne O’Reilly, SVUH
Dr Karl Hazel, Connolly Hospital, Blanchardstown
Leave a Reply
You must be logged in to post a comment.